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Understanding Breast Biopsies

You do a breast self-exam every month and have a mammogram every year. Everything has always been fine, but then your doctor calls to say the results of your last mammogram were not normal and you need to have a breast biopsy. Your first thought is - “Why? Do I have breast cancer?”


A biopsy can be used to diagnose breast cancer, but most lumps are not cancer. In fact, results for four out of five biopsies are non-malignant. So if you do not have cancer, what do you have?


Benign or non-cancerous breast conditions fall into two main categories, neither of which is life-threatening. Fibrocystic changes in the breast often occur before a period, causing cysts and areas of lumps, tenderness or nipple discharge. Benign breast tumors are areas of breast cells that have grown abnormally and rapidly to form lumps that may be uncomfortable, but they do not spread outside the breast to other organs.


A breast biopsy involves taking a sample of connective tissue, fat lobules or milk ducts to check for cancer or other breast conditions. There are several ways to perform a biopsy. Your doctor will recommend the procedure that is right for you.


During a fine-needle aspiration biopsy, a thin needle is passed through the skin to the lump and cells are removed for examination. A needle biopsy can be done to see if the lump is solid or a fluid-filled cyst. If there is no fluid, another type of biopsy is done; if it is a cyst, it should go away after the fluid is removed.


A slightly larger, hollow needle with a special tip is used during a core needle biopsy. During this procedure, three to six tissue samples are removed, sometimes using vacuum suction. A core needle biopsy is more likely to provide definite results because more tissue is removed for study. During a fine-needle or core needle biopsy, the doctor usually guides the needle to the abnormal area by palpating (feeling) the lump.


If the area being studied is too small to be felt, the doctor may perform a stereotactic needle biopsy using X-ray images to locate where the sample will be taken. Ultrasound also may be used to guide the needle into very small tumors or cysts.


A surgical biopsy involves making an incision to remove part of the lump (incisional biopsy), or the entire lump and some surrounding tissue (excisional biopsy or lumpectomy). If the lump is too small to be located easily, a flexible wire may be inserted into the suspicious area using X-rays to help guide the surgeon to the lesion. This is called wire localization.


If your doctor recommends that you have a biopsy, do not assume the worst. Approximately one million American women are diagnosed with benign breast disease each year. Breast biopsy is generally considered to be a safe, outpatient procedure. If you have any questions about your biopsy, talk with your doctor or get a second pathology review of your results. Even if you do not have cancer, it is important to have regular mammograms, watch for any changes in your breasts, and see your doctor for routine breast exams.
The Women's Imaging Center at Cy-Fair Hospital offers stereotactic and ultrasound-guided biopsies. For information and to schedule, please call 281-897-3121. To find a physician to discuss your breast health concerns, call our free physician referral service at 800-681-2733.